[The repeated operations for focal liver lesions].

Repeated operations for focal liver lesions were analyzed. 75 patients with parasitic liver lesions (alveococcosis, echinococcosis), 14 patients with liver tumors, 15 patients with cysts and abscesses were included in the study. For the first time patients underwent palliative operations or diagnostic laparotomy. In some patients relapse was observed after radical surgery in postoperative period. Ultrasound study was the main diagnostic method for detecting localization and extent of the lesion. 91 patients underwent radical surgery, including hemihepatectomy carried out to 26 patients, segmental and bisegmental liver resections carried out to 35 patients. Transparenchymatous Tung ligation was used in liver resections. Resection line was covered by hemostatic sutures according to B.I. Alperovich technique. Intraparenchymatous processing of Glisson pedicle according to E.I. Galperin method was applied in extensive liver resections. Cryodestruction was used for prophylaxis of relapses in parasitic and tumor lesions. Liver failure (4) and bleedings (2) were the most life-threatening postoperative complications. 4 patients died due to liver failure (2) and bleedings (2). Among 97 patients good results were observed in 73 (75,3%) patients, satisfactory - in 22 (22,7%), poor - in 2 (2,1%) with relapse of hepatocellular carcinoma.

[Cryosurgery of hepatic tumors]. / Kriokhirurgiia opukholei pecheni.

The work presents an experience with cryosurgical treatment of malignant and benign tumors of the liver in 110 patients. The cryosurgery was performed using an original apparatus. The methods of resection of the liver using cryosurgical instruments are described which reduce the intraoperative blood loss and facilitate visualization of the vascular-tubular structures along the resection line. The use of low temperatures allows optimization and extension of indications for operative interventions. Cryodestruction of the residual portion of the liver tissue after resection can be taken as a subsidiary means for prevention of dissemination of tumor cells.

[Sucking effect of diaphragm and its significance in drainage of abdominal cavity during hepatic surgery]. / Prisasyvaiushchii éffekt diafragmy i ego znachenie pri drenirovanii briushnoi polosti pri operatsiiakh na pecheni.

Investigation of the value of the sucking effect of the diaphragm in 44 patients was carried out. The first group consisted of 28 patients who have not undergone hepatic resection. The second group included patients after hepatic resections of various volume in local pathology. The balloon method in modification of this clinic was used for measurement of the value of the sucking effect. In patients of the first group the value of sucking effect was almost two times more under the right cupula of the diaphragm (130.33 + 4.78 mm of water column) in comparison with the left infradiaphragmatic space. It is responsible for presence of the slot between the right half of the liver and the diaphragm, which aggravates the sucking effect. In the second group of patients the value of the sucking effect under the right diaphragmatic cupula was practically the same as in patients of the first group. After right-sided hemihepatectomy the value of the sucking effect under right cupula of the diaphragm has significantly diminished. After resection of the right lobe of the liver as well as after left-sided hemihepatectomy, or without them, the value of sucking effect under left cupula of the diaphragm did not significantly differ. The investigations showed that vacuum-aspiration with vacuum of not less than 150 mm water column should be used for effective drainage of infradiaphragmatic space.

[The effect of immune system disorders on the incidence of inflammatory complications in surgeries on the liver]. / Vliianie narushenii immuniteta na chastotu gnoinykh oslozhnenii u bol'nykh pri operatsiiakh na pecheni.

Inflammatory complications in the abdominal cavity are the most frequent complications after operations on the liver. Immunological studies were conducted in 71 patients with local lesions of the liver who had undergone various surgical interventions. Cellular and humoral immunity factors were studied. The absolute and percentage content of T- and B-lymphocytes and the level of the main three classes of immunoglobulins-A, M and G were determined. The authors noted a definite correlation between the degree of disturbance of the immune system and preoperative complications, preoperative complications of the principal disease (purulent complications--suppuration of the cavity of disintegration of the alveococcus, abscesses of the liver), functional condition of the liver, and postoperative purulent complications. The treatment of inflammatory complications in the postoperative period (suppuration of residual cavities after resection of the liver and echinococcotomy, subdiaphragmatic and subhepatic abscesses) was more effective in patients with mild changes in immunological parameters.

[Complications after resection of the liver]. / Oslozhneniia posle rezektsii pecheni.

On the basis of experience in 228 radical resections of the liver (3.9% lethality) for focal affections, the authors analyze the causes of occurrence and measures of prevention of the main postoperative complications. The following factors play a role in the development of complications after liver resection: the patient's age, the character of the main and concomitant pathology, the volume of the operation and intraoperative blood loss, and the method of drainage. The prevention of postoperative complications is based on careful selection of patients for the operation, preoperative management, sparing operative techniques, adequate anesthesiological and trans-infusion service during the intervention, the use of cryoapparatuses and active management in the early postoperative period.

[Drainage of the abdominal cavity after resection of the liver because of tumors]. / Drenirovanie briushnoi polosti posle rezektsii pecheni po povodu opukholi.

After resection of the liver for benign and malignant tumours, 20 (44.4%) of the 45 patients developed purulent complications in the abdominal cavity. In most of them, ineffective drainage of the abdominal cavity was the main cause of such complications. For effective drainage of the abdominal cavity with active aspiration, a plait-like drain consisting of 4-5 tubes was suggested. The drain was used in 5 patients, no purulent complications occurred.

[Treatment of abscesses of the upper abdominal cavity after surgery on the liver]. / Lechenie abstsessov verkhnego étazha briushnoi polosti posle operatsii na pecheni.

Complications after 454 various operations on the liver are analysed. Abscesses of the upper part of the abdominal cavity (subdiaphragmatic and subhepatic abscesses, suppuration of residual cavities after resection of the liver and echinococcotomy) developed in 18.5% of patients in the postoperative period. Inadequate drainage of the abdominal cavity was among the main causes of such complications. The authors suggest an original method for drainage of the abdominal cavity after operations on the liver. With its use the number of these complications was three times less. It was found that in 40.5% of cases abscesses of the upper abdominal cavity may be cured by nonoperative measures, by puncture of the purulent cavity under control of ultrasonic examination and introduction of drains for subsequent aspiration. A surgical intervention is still the main method for the treatment of abscesses of the upper abdominal cavity. The success of the operation is determined to a great measure by effective drainage. A drainage method is suggested which allowed the time needed for the treatment in cases with such complications to be reduced almost by half.

[The diagnosis and treatment of mechanical jaundice of parasitic origin]. / Diagnostika i lechenie mekhanicheskikh zheltukh parazitarnogo proiskhozhdeniia.

From analysis of 230 cases of obstructive jaundice consequent upon opisthorchiasis, alveococcosis, and echinococcosis its causes and the peculiarities of the clinical course were revealed: gradual development, a long duration, disturbed hepatocyte function in the early period, high incidence of cholangitis, deep disorders of immunological reactivity, and allergic reorganization of the organism. With due regard for these characteristics, recommendations are given in respect of the diagnosis, operative treatment, prevention of postoperative complications, and postoperative management.

[A rare case of infiltrative growth of alveococcus in the aorta and its branches]. / Redkoe nabliudenie vrastaniia al'veokokka v aortu i ee vetvi.

Widespread liver alveococcosis resulted in the infiltrative growth into the celiac and superior mesenteric arteries with their complete obturation with the parasitic tissue, but without the disturbance of circulation in the digestive organs. This was due to slow obliteration and the development of collateral circulation.

[The role of determining the level of middle molecules in patients in the diagnosis and treatment of suppurative-inflammatory complications after operations on the liver and pancreas]. / Rol' opredeleniia urovnia molekul srednei massy u bol'nykh v diagnostike i lechenii gnoino-vospalitel'nykh oslozhnenii posle operatsii na pecheni i podzheludochnoi zheleze.

Investigations of the level of medium-mass molecules were performed in blood plasma of 52 patients in dynamics after different operations on the liver and pancreas. Significant elevation of the level of medium-mass molecules was noted in patients with pyo-inflammatory complications. The inverse relationship between the level of medium-mass molecules and the prognostic coefficient value (the ratio of the general plasma protein to the general protein of wound discharge) was revealed. The indicators of the prognostic coefficient value decreased when the level of the medium-size molecules elevated against the background of purulent complications. These data allowed to estimate the severity of purulent complications and degree of intoxication which helped to determine the correct method of treatment of patients and to timely detect pyo-inflammatory complications.

[Opisthorchiasis of the liver]. / Opistorkhoznye kisty pecheni.

The authors discuss 34 patients with opisthorchiasis cysts of the liver, 17 of them were treated by operation. The disease is not a rare occurrence in endemic foci. Ultrasonography is considered to be the most informative method in the diagnosis of opisthorchiasis hepatic cysts. Patients with cysts of moderate and large size (more than 5 cm) are subjected to surgery. Those with cysts of a small diameter are kept under dynamic observation. It is claimed that in untreated opisthorchiasis additional drainage of the biliary tract during the operation is expedient. Opisthorchiasis cysts of the liver possess characteristic morphological signs; the wall of the cyst is usually formed by the walls of the distended bile ducts with marked adenomatous growths of the epithelium. The authors show the late-term results of surgery in follow-up periods of 2 to 11 years, which they claim to be quite satisfactory.

[The late results of liver resection in repeat operations]. / Otdalennye rezul'taty rezektsii pecheni pri povtornykh operatsiiakh.

Long-term results after resections of the liver in reoperated patients are described. The operations were performed on 48 patients. Four of them died (8.4%). The patients were followed-up during 1-15 years. The volume of the operations was from segment resections up to wide hemihepatectomies. Good long-term results were obtained in 82.7% of the patients, satisfactory--in 13.9%, unsatisfactory--in 3.4%. The use of cryosurgical methods in palliative resections gives better long-term results of the operations. Recurrences were noted in 17.2% of the patients. Labor rehabilitation after vast resections of the liver in reoperated patients takes place within 1.5-2.5 years.

[Ultrasonic diagnosis of complications in repeated surgery of the liver]. / Ul'trazvukovaia diagnostika oslozhnenii pri povtornykh operatsiikh na pecheni.

Ultrasonic examination is an effective noninvasive method in the diagnosis of complications in reoperations on the liver. With the application of the method the cavity of disintegration and sequestration were diagnosed in 86% of patients with complicated alveococcosis. Affection of the elements of the porta hepatis and inferior vena cava was revealed in 82% of patients, which was very important in determining the operability of the process and was of essential significance in planning the volume of liver resection. Right pleuritis, the formation of a residual cavity, and sequestration of the parasitic and hepatic tissue are also diagnosed adequately in the postoperative period by means of ultrasonic examination.

[The classification of cryosurgical resections of the liver in reoperated patients]. / Klassifikatsiia kriokhirugicheskikh rezektsii pecheni u povtorno operirovannykh bol'nykh.

The authors present a classification of cryosurgical operations in resection of the liver in reoperated patients. The basis of this classification is different combination of usual and cryosurgical (cryoresection and cryodestruction) methods, which allow to increase the radicality of the operations. Ten kinds of cryointerventions (5 radical and 5 palliative) were established. The classification proposed allows the operative volume for resection of the liver in reoperated patients to be correctly planned.